Role of Transverse Abdominis Plane Block in Laparoscopic Donor Nephrectomy

Post-operative wound pain is a disincentive to potential live kidney donors. The transverse abdominis plane (TAP) block is a technique where the local anaesthetic agent is given to block the afferent nerves of the abdominal wall. The safety and efficacy of this technique is well established for other surgical procedures. The TAP block technique is shown to be beneficial and reduced the postoperative morphine requirement in lower abdominal surgeries such as hysterectomy, appendicectomy, and caesarean section. A similar incision is being used for retrieval of kidney after laparoscopic donor nephrectomy. This technique has never been tested before in laparoscopic donor nephrectomy patients; hence the aim of thesis was to establish the efficacy of TAP block in reducing the pain and assessing its impact on reducing total morphine requirement. An initial retrospective study showed a potential of TAP block to reduce postoperative pain and cumulative postoperative morphine requirements. Thereafter based on these results, a double blinded randomised placebo controlled trial was setup. The randomised trial has demonstrated that a TAP block with bupivacaine reduced early morphine requirement at 6 hours. But, there was no difference seen in the total postoperative morphine usage. The visual analogue pain score in TAP block group with bupivacaine was significantly lower on day 1 and 2 after surgery. Further cytokine assay in this randomised study showed no difference in the plasma cytokine levels at 6, 24 and 48 hours after donor nephrectomy. Hence the TAP block technique appears to be a safe and effective method of postoperative pain in laparoscopic donor nephrectomy patients. The study thus established the contributory role of TAP block in multimodal analgesia. This can be an alternative to post-operative wound infiltration with local anaesthetic agents.